1. RHEUMATOID ARTHRITIS PRESENTED BY: DR.ABD ELRHMAN ABD ELMONIEM KHOGALII

2. Rheumatoid Arthritis Definition Rheumatoid arthritis is a chronic disease that causes inflammation in the joints and certain other organs throughout the body. It is called an autoimmune disorder. It is believed that the body's immune system accidentally mistakes its own tissues for foreign invaders. The immune system attacks the joints and organs, causing damage. Characterized by: Symmetrical inflammatory polyarthritis Extera-articular involvement Progressive joint damage causing severe disability

4. Defects in the immune system can cause ongoing inflammation.

5. Environmental factors-Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.

7. Age ; can develop at any age, you're most likely to develop the condition between the ages of 25 and 45.

8. Gender ; Women are to 3 times more likely to develop rheumatoid arthritis than men.

11. Morning stiffness and pain that lasts more than 30 minutes

12. Pain and stiffness symmetrically (that is, both feet or both hands are affected, as opposed to only one)

13. Red, swollen, warm joints

14. Deformed, misshapen joints.Other symptoms of rheumatoid arthritis include: Intense fatigue, decreased energy Muscle aches Decreased appetite Weight loss Fever and sweats

15. Depression Problems sleeping Anemia Bumps occurring under the skin (rheumatoid nodules) Inflamed blood vessels Bleeding stomach ulcers Inflammation of the heart's sac ( Pericarditis) Inflammation of the heart muscle ( Myocarditis) Lung problems Eye problems

17. wrist , knee ,ankle and toe

19. Sublaxation of metacarpophalangeal joint

20. Swan neck deformity

21. Button-hole deformity

22. Z-deformity of thumb

25. Valgus and virus deformitiesD/D from osteoarthritis : in (OA) the number of joints affected is much less than (RA). in (RA) distal interphalangeal joint is spared while in (OA) it is characteristically involved. The joint most commonly involved in (OA) are weight bearing e.g. knee and hip joints.

27. Arthritis in at least three joints

28. Arthritis of the joints of the hand

29. Arthritis on both sides of the body

30. A positive blood test for rheumatoid factor (RF)

31. Presence of lumps under the skin, called rheumatoid nodules

32. X-rays that show signs of rheumatoid arthritis affecting the joints. (With duration of sex weeks or more , diagnosis of RA made with 4 or more criteria )

34. Anti citrullinated peptide antibody (anti cpp)

35. Erythrocyte sedimentation rate

36. Antinuclear antibody

39. (2) loss of articular cartilage resulting in loss of joint space.

40. (3) Erosions gives mouth-bite appearance on the surface of The affected bone.

41. (4) Subluxation and Ankylosis. these 4 stages indicate the advancement of the disease process MANAGMENTS : there are 5 stages in management of RA with , LOCAL MANAGEMENT include rest splints Inter-articular corticosteroid injection. SYSTEMIC MANAGEMENT include NON-steroidal anti-inflammatory drugs Simple analgesics Slow acting disease modifying anti-rheumatic dugs e.g. antimalarial , sulphasalazine , penicillamine

43. Education of the patient and reassured

46. Bursitis.

47. Tenosynovitis.

49. Atlanto-axial subluxation.

51. Scleritis.

54. Diffuse fibrosing alveolitis.

55. Rheumatoid nodules in the lungs.

58. Splenomegaly.